One hundred years ago, 90% of childhood deaths were caused by natural causes; this figure has steadily decreased. By 1985, only 36% of all childhood deaths were due to natural causes, and only 25% of all urban children died of natural causes. Do these percentages represent a victory for modern medicine or a profound failure? Perhaps these numbers are a testament to the success of efforts to provide clean water, improved nutrition, enhanced access to prenatal care, and prevention of infectious disease—a victory for modern medicine. But if children are not dying of natural causes, they are dying of an “unnatural” cause—that is, trauma—and we have not made parallel progress in stemming its toll. Our general failure to affect trauma can be traced to insufficient efforts to broaden the medical response to include primary, secondary, and tertiary injury prevention. As a bumper sticker on my bulletin board notes, “Injuries are not accidents.”